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Glossary > Vision Coverage

Vision Coverage

What is Vision Coverage?

Vision coverage is the same as vision insurance, and it covers or reduces costs associated with your eye care. You pay a monthly premium as you would with health insurance, and in return, your vision care needs will be covered by your insurer.

Each plan and provider is slightly different in what it will and will not cover, including the eye doctors you can visit. Many providers prefer or require you to stay within their network. You will likely need to pay a deductible or copay too. Another option for vision plans are vision discount plans. Please don't confuse them with vision insurance. These cost as little as nothing on a month-to-month basis. However, you will pay the difference at the time you have your vision checked or buy glasses or contacts.

What is Covered Under Vision Insurance?

Each plan and company’s coverage may vary, but you can expect to see the following covered fully or in part:

  • Basic lenses or lenses with a scratch resistant coating - Tint and automatic tinting lenses are usually not covered.
  • Frames - Some companies work on reimbursement and don’t pay up front for frames. Price caps may also be used.
  • Contact lenses - Type varies and usually doesn’t cover daily lenses, eye color changing, or fashion contacts.
  • Preventative eye exams - Typically one exam every two years unless medically necessary.
  • Emergency eye exams - Eye injuries, infections, or other eye trauma is generally covered. Emergencies might require a referral from a primary care physician. Some insurance companies will also provide coverage for daily contact lenses, but this may increase premiums too. Another add-on option sometimes available are discounts on corrective eye surgery. Be sure to ask your provider if they offer additional services.
  • Is Vision Covered Under Obamacare?

Yes and no. Full vision insurance is available for children enrolled in an Affordable Care Act (ACA) plan, but it isn’t a separate insurance. For adults, medical vision care, such as cataract surgery, is covered, but you won’t find vision insurance for wellness exams or your eyewear, eyeglass lenses, and contact lenses in the ACA Marketplace. This isn't expected to change any time soon.

Do You Need Vision Coverage?

Most likely, yes. If you or someone who would be on the vision plan already wear glasses or contacts, vision coverage will likely save you more than it costs without it. If you have a family history of poor eyesight, you will benefit from a vision plan. Bi-yearly or yearly eye examinations can catch early signs of cancer, diabetes, hypertension, and other life-threatening diseases. Poor eyesight is also a common factor for many who suffer from headaches and migraines. However, if you’re under 39 and have good vision and no family history of eye-related diseases, you will likely save money foregoing vision coverage.

Vision Coverage Cost

Costs differ based on a few factors, such as where you live, how many people will be on your vision insurance policy, and which doctors you choose. Major vision plans start at less than $20 per month, per person. Children on plans can cost less, so age is also a factor.

If vision coverage is available through your employer, you may be able to use their coverage for additional savings. Keep in mind these vision insurance costs might be higher if they don’t fully cover frames and lenses. When choosing a provider, you should always ask if there will be deductibles or any additional out-of-pocket fees, such as copay. Also, ask if anything is excluded from your coverage. This way you’re not caught off guard.

Vision Coverage Cost Without Health Insurance

Prices are rough estimates and some areas will be cheaper for vision plans. These prices don’t include specials or in-store discounts; although it never hurts to ask whether you have vision insurance or not. Without vision plans, a yearly eye exam costs roughly $128.00. This doesn’t include glasses, lenses, or contact lenses. Some doctors charge new patient fees, and this can bring the exam total to about $200.00.